Kitahara Hideki, Yamazaki Tatsuro, Hiraga Takashi, Suzuki Sakuramaru, Ohno Yuji, Harada Junya, Fukushima Kenichi, Asano Tatsuhiko, Ishio Naoki, Uchiyama Raita, Miyahara Hirofumi, Okino Shinichi, Sano Masanori, Kuriyama Nehiro, Yamamoto Masashi, Sakamoto Naoya, Kanda Junji, Kobayashi Yoshio
Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine.
Department of Cardiovascular Medicine, Eastern Chiba Medical Center.
Circ J. 2025 Jan 24;89(2):195-203. doi: 10.1253/circj.CJ-24-0418. Epub 2024 Dec 20.
Underdoses of direct oral anticoagulants (DOAC) are sometimes prescribed due to bleeding risk concerns in patients with atrial fibrillation (AF). We investigated the prevalence of DOAC underdosing and its impact on clinical outcomes in AF patients undergoing percutaneous coronary intervention (PCI).
This multicenter observational cohort study enrolled patients with AF on DOAC undergoing PCI between January 2015 and March 2021 at 15 institutions across Japan. Clinical outcomes within 1 year, including major adverse cardiovascular events (MACE), all-cause mortality, ischemic stroke, and major bleeding events, were evaluated. Of 623 patients enrolled, 167 (26.8%) received underdoses, 224 (36.0%) received appropriate low doses, 210 (33.7%) received appropriate standard doses, and 22 (3.5%) received overdoses. Clinical outcomes were compared between patients with underdoses (n=167) and appropriate doses (n=434). Although the incidence of MACE, all-cause mortality, and major bleeding events did not differ significantly between the 2 groups (log-rank P=0.850, P=0.163, and P=0.711, respectively), ischemic stroke occurred more frequently in the underdose than appropriate-dose group (log-rank P=0.011). After propensity score matching, the same result was observed for the frequency of ischemic stroke (log-rank P=0.026).
Compared with appropriate doses of DOAC, DOAC underdosing was associated with a higher incidence of ischemic stroke, despite no significant difference in MACE, all-cause mortality, and major bleeding events in AF patients undergoing PCI.
由于对心房颤动（AF）患者出血风险的担忧，有时会开出低于标准剂量的直接口服抗凝剂（DOAC）。我们调查了接受经皮冠状动脉介入治疗（PCI）的AF患者中DOAC剂量不足的发生率及其对临床结局的影响。
这项多中心观察性队列研究纳入了2015年1月至2021年3月期间在日本15家机构接受PCI治疗且正在服用DOAC的AF患者。评估了1年内的临床结局，包括主要不良心血管事件（MACE）、全因死亡率、缺血性卒中以及大出血事件。在纳入的623例患者中，167例（26.8%）接受了低剂量治疗，224例（36.0%）接受了适当的低剂量治疗，210例（33.7%）接受了适当的标准剂量治疗，22例（3.5%）接受了过量治疗。比较了低剂量组（n = 167）和适当剂量组（n = 434）患者的临床结局。虽然两组之间MACE、全因死亡率和大出血事件的发生率无显著差异（对数秩检验P分别为0.850、0.163和0.711），但低剂量组缺血性卒中的发生率高于适当剂量组（对数秩检验P = 0.011）。倾向评分匹配后，缺血性卒中的发生频率也得到了相同的结果（对数秩检验P = 0.026）。
与适当剂量的DOAC相比，在接受PCI的AF患者中，尽管DOAC剂量不足在MACE、全因死亡率和大出血事件方面无显著差异，但与缺血性卒中的较高发生率相关。
